Dual Diagnosis Inpatients: Telephone Monitoring RCT to Improve Outcomes

Background:

Substance use disorders (SUDs) are highly prevalent among veteran psychiatry inpatients.
Dual substance use and psychiatric disorders are related to poor outcomes and
rehospitalizations, which are quite costly. However, relatively little is known about how
to effectively help dually diagnosed psychiatry inpatients. Telephone Monitoring (TM) is
effective among SUD patients at increasing SUD continuing care and self-help utilization and
improving SUD outcomes. This study will build on these findings and contribute important
new clinical knowledge by determining whether TM is similarly effective when adapted for
dually diagnosed veteran psychiatry inpatients. It will evaluate the effectiveness of a
manual-guided TM intervention.

Objectives:

Primary hypotheses are that patients in the TM condition, compared to patients in usual care
(UC), will attend more SUD continuing care sessions and 12-step group meetings, and have
better SUD and psychiatric outcomes. Secondary hypotheses are that TM patients will have
fewer and delayed rehospitalizations, and their better outcomes will be mediated by SUD
outpatient treatment and 12-step group participation.

Methods:

This study will take place at two VAs: Palo Alto (VISN 21) and Ann Arbor (VISN 11). Dually
diagnosed patients in psychiatry inpatient treatment will be randomly assigned to UC or TM.
Patients in the TM condition will receive an in-person session while in treatment, followed
by monitoring over the telephone for three months after discharge. The intervention will
incorporate motivational interviewing to monitor patients' substance use, facilitate entry
into outpatient treatment if a relapse occurs, and encourage 12-step self-help group
participation. Patients will be assessed at baseline, end-of-intervention, and six months
and one-year post-intervention for primary and secondary outcomes and non-VA health care; VA
health care will be assessed with VA databases. GLMM analyses will be conducted to compare
the UC and TM groups on course of primary and secondary outcomes over time; Cox regression
models will compare groups on time to rehospitalization; and sequential regression analyses
will examine whether outcomes associated with TM are mediated by more SUD continuing care
and 12-step group participation.

Status:

Currently, this project is in the data collection phase.

Inclusion Criteria:

- Dually diagnosed veteran in VA inpatient psychiatry treatment

Exclusion Criteria:

- Current diagnosis of schizophrenia or schizoaffective disorder

- too psychiatrically unstable or cognitively impaired to understand informed consent
and other study procedures

- does not have ongoing telephone access